Insulin resistance and β-cell function influence postprandial blood glucose levels in Japanese patients with gestational diabetes mellitus

Abstract

Aims/introduction: The aim of this study in patients with gestational diabetes mellitus (GDM) was to evaluate the relationship of insulin resistance and secretion to area-under-the-sensor glucose concentration–time curve from before to 120 min postmeal (CGM-AUC_{0–120 min}) as determined with continuous glucose monitoring (CGM).

Materials and methods: Immunoreactive insulin and HbA1c were determined in 22 Japanese patients with GDM undergoing a 75 g oral glucose tolerance test. Patients underwent CGM within 3 weeks of receiving a diagnosis of GDM.

Results: HbA1c (NGSP) was 5.5 ± 0.4%, BMI was 24.8 ± 5.3 kg/m², mean sensor glucose by CGM was 94.2 ± 10.3 mg/dL, standard deviation was 17.5 ± 4.4 mg/dL, and CGM-AUC_{0–120 min} was 204.2 ± 23.8 h mg/dL. The insulin resistance indices the homeostasis model assessment ratio (HOMA-R), quantitative insulin sensitivity check index (QUICKI), and the Matsuda Index were correlated with CGM-AUC_{0–120 min}. The disposition index (DI), which was used to evaluate insulin secretion, was negatively correlated with CGM-AUC_{0–120 min}.

Conclusions: Not only insulin resistance but also beta cell dysfunction contributes to postprandial hyperglycemia in Japanese patients with GDM.

Chinese abstract

目的/介绍：本试验旨在研究合并妊娠期糖尿病（GDM）的患者，在用餐前和用餐后120分钟，胰岛素抵抗和释放，与葡萄糖浓度-时间曲线下面积（CGM-AUC_0-120min）之间的关系，主要应用动态血糖监测的方法（CGM）进行测定。

方法和对象：免疫反应的方法检测合并GDM的22例患者，在进行75g口服葡萄糖耐量试验后，胰岛素和HbA1c的水平。在3周内进行CGM后诊断为GDM。

结果：HbA1c（NGSP）为5.5±0.4%，BMI为24.8±5.3kg/m²， CGM检测的平均葡萄糖传感浓度为94.2±10.3mg/dL, 平均偏差为17.5±4.4mg/dL, CGM-AUC_0-120min为204.2±23.8hmg/dL。稳态胰岛素抵抗指数（HOMA-R），定量胰岛素敏感性检测指数（QIUCKI），松田指数与CGM-AUC_0-120min有关。处置指数（DI），用于评估胰岛素释放，与CGM-AUC_0-120min无关。

结论：不仅是胰岛素抵抗，同样β细胞功能紊乱均可导致合并GDM的日本患者餐后高血糖。

Keywords:

• β-Cell function
• continuous glucose monitoring
• gestational diabetes mellitus
• insulin resistance
• 75 g oral glucose tolerance test

Acknowledgements

We would like to thank all personnel at the Dept. of Obstetrics and Gynecology, Hyogo College of Medicine, for collaborating closely with us, and for diagnosis and treatment of patients.

Declaration of interest

The authors report that they have no conflicts of interest.